Provider Demographics
NPI:1295926012
Name:WALTER, RICHARD D JR (PTA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:WALTER
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 N BELSAY RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2223
Mailing Address - Country:US
Mailing Address - Phone:810-250-0702
Mailing Address - Fax:
Practice Address - Street 1:3399 N BELSAY RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-2223
Practice Address - Country:US
Practice Address - Phone:810-250-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant